Keith Sakata, MD (@KeithSakata) / X

Keith Sakata, MD

3,302 posts

Keith Sakata, MD

@KeithSakata

Psychiatrist @ UCSF | Stanford Med | Clinical Lead @ Sunflower | Sharing all things mental health and tech

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linkedin.com/in/keithsakata/

Joined August 2023

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Keith Sakata, MD
@KeithSakata
Oct 11, 2025
You know what’s kinda cooler than the brain? Space! My photography attempts at the Orion Nebula over the past couple years.
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
I’m a psychiatrist. In 2025, I’ve seen 12 people hospitalized after losing touch with reality because of AI. Online, I’m seeing the same pattern. Here’s what “AI psychosis” looks like, and why it’s spreading fast: 🧵
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
Replying to @KeithSakata
[7/12] Historically, delusions follow culture: 1950s → “The CIA is watching” 1990s → “TV sends me secret messages” 2025 → “ChatGPT chose me” To be clear: as far as we know, AI doesn't cause psychosis. It UNMASKS it using whatever story your brain already knows.
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
Replying to @KeithSakata
[2/12] Psychosis = a break from shared reality. It shows up as: • Disorganized thinking • Fixed false beliefs (delusions) • Seeing/hearing things that aren’t there (hallucinations)
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
Replying to @KeithSakata
[3/12] First, know your brain works like this: predict → check reality → update belief Psychosis happens when the "update" step fails. And LLMs like ChatGPT slip right into that vulnerability.
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
Replying to @KeithSakata
[5/12] Third, we trained them this way. In Oct 2024, Anthropic found humans rated AI higher when it agreed with them. Even when they were wrong. The lesson for AI: validation = a good score
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
Replying to @KeithSakata
[6/12] By April 2025, OpenAI’s update was so sycophantic it praised you for noticing its sycophancy. Truth is, every model does this. The April update just made it much more visible. And much more likely to amplify delusion.
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
Replying to @KeithSakata
[4/12] Second, LLMs are auto-regressive. Meaning they predict the next word based on the last. And lock in whatever you give them: “You’re chosen” → “You’re definitely chosen” → “You’re the most chosen person ever” AI = a hallucinatory mirror 🪞
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Keith Sakata, MD
@KeithSakata
Jul 19, 2025
Replying to @NTFabiano
Firstborns aren’t just slightly smarter, they’re more likely to explain, to argue, to abstract. Even in different family sizes they engage in science discourse more often.
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
Replying to @KeithSakata
[8/12] Most people I’ve seen with AI-psychosis had other stressors = sleep loss, drugs, mood episodes. AI was the trigger, but not the gun. Meaning there's no "AI-induced schizophrenia"
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
Replying to @KeithSakata
[9/12] The uncomfortable truth is we’re all vulnerable. The same traits that make you brilliant: • pattern recognition • abstract thinking • intuition They live right next to an evolutionary cliff edge. Most benefit from these traits. But a few get pushed over.
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
Replying to @KeithSakata
[11/12] Tech companies now face a brutal choice: Keep users happy, even if it means reinforcing false beliefs. Or risk losing them.
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
Replying to @KeithSakata
[10/12] To make matters worse, soon AI agents will know you better than your friends. Will they give you uncomfortable truths? Or keep validating you so you’ll never leave?
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Keith Sakata, MD
@KeithSakata
Aug 11, 2025
Replying to @KeithSakata
[12/12] For more on schizophrenia and psychosis:
Keith Sakata, MD
@KeithSakata
Jul 18, 2025
In 2025, I have admitted 12 cases of psychosis to the hospital with LLM involvement. 1. This actually isn't new or AI-specific. 2. And no AI does not causes psychosis. And most importantly, 95% of what you're reading on X about "schizophrenia" is medically inaccurate. 🧵
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